Red Lake Take Three

None of the articles mention the local indian hospital. But presumably the triage occurred there first.

I have no details on this, but alas murderous outbreaks are not unknown to IHS doctors. I have been through two: One where five died on one of the Sioux reservations in South Dakota, and one where five were stabbed and one died in Red Lake. And mass casualties are not unknown in rural hospitals, although most that I have worked on have been major car wrecks.

I'll summarize the Red Lake incident, partly because it shows how the culture works, and partly to show how a small rural hospital copes with mass trauma.

It was about ten years ago, and I was a GP and not on call. Most of the doctors lived off reservation because white kids can't go to Indian schools. But the doctor on call had to be nearby, and we always had an Emergency room doctor hired from the civilian sector.

What woke me that night was hearing two ambulances going out-- this meant something bad was probably going to come in, so I got dressed, and sure enough, a few minutes later I got a call to get to the hospital STAT...

When we had any "mass casualty" situation, there was a list of everyone nearby, whether on or off duty. I lived there, so usually was called. And any other doctor around was called (sometimes we had temporary doctors, or ER doctors staying over between shifts)... The nurses living nearby were called, as were lab, Xray, all the nearby EMT's (ambulance workers), and dietary. (To supply coffee for staff and family members).

Usually we called the nearby Catholic priest to give last rites and console the family members.(Our priest then was an older, very holy priest...He even had permission from the local medicine man to pray over patients who followed traditional religion). If he was not available, the Episcopal priest was called from the next town. Social workers and secretaries often came to help with family and with paper work. Family were called, of course...and often extended family if we had time...

Walking to the hospital, I knew it was bad, because there was loud crying and shouting at the emergency entrance...relatives were fighting with the security guards keeping them out....

I went in, and found one of our basketball team boys lying dead. They had just stopped the "code" (i.e. CPR). There were three other stab victims waiting for evaluation but were stable, so I examined them while the ER doctor talked to the family, and transfer the body to a room where family could mourn in private.

Three thugs crashed a graduation party, and got into a fight with some of the graduates, and stabbed three or four kids. The dead boy, a champion basketball player, was stabbed in the heart.

The family called the ambulance, but both our ambulances were called west to a very bad car wreck, and the nearest ambulance was 30 miles north, would take ten minutes to get to the graduation party, and ten more minutes to get to the hospital...so the family placed him in a car and brought him in, alas, DOA from a stab wound to the heart....

I helped transfer two other patients to North Country hospital, one with a small pneumothorax (collapsed lung) and one who was only minor injury (the stab wound did not enter the chest cavity)...we sent them to North Country hospital in the same ambulance, so they could get a stat CT scan and a chest tube if needed...or if needed, blood...(they both were okay). We could put in chest tubes, but had no blood and no surgeon...This meant a lot of phone calls, getting IV's started ( the trip took 28 minutes if the road was clear).

I did this because two minutes later, three critical patients from the car accident came in. One man had pulled out of a driveway onto the main hiway, but didn't see the oncoming car, which couldn't stop, so broadsided his car...it took almost an hour to get him from the very badly smashed car.

The temporary doctor took care of the little girl-- turned out she had a fractured femur, and we stablized her and transferred her about four hours later to get orthopedic treatment.

The doctor on call got her father, who ended up fine but had six rib fractures. (thank God for seat belts). He was admitted for observation.

But the third patient was the critical one, and the ER doctor, who had the most experience with trauma, started working on him. The patient had a severe head fracture, a fracture of his arm and internal injuries. It took an hour for the EMT and fire dept to extricate him from a badly smashed car. The ER doctor intubated him, we started fluids, and we arranged a helicopter to transfer him to Fargo. I didn't help with the case, but his stepmother was my patient, so I spent most of the time consoling her and helping to arrange the helicopter ambulance... (he lived, by the way)...

Now, transfer by ambulance was not uncommon, but in norther Minnesota, you can't always do this. If there is poor visibility, or it's snowing or windy, you can't bring in a helicopter. So you have to send to North Country Hospital and if they can't handle it, transfer either by ground or fixed wing to Fargo or Minneapolis.

Nurses can often arrange this, but doctors have to talk to other doctors to give the details. And our secretaries were the ones xeroxing records to go along.

I don't remember what time I got to bed that night, but it was a bad night.

Living on a reservation shows you really terrible things...but it also shows you hope...how people despite these terrible things, despite the rampant alcoholism, despite the despair, still worry about each other and help each other.

No one-- and I mean no one-- died neglected or alone.